Therapies for Severe Hypercalcemia
| Treatment | Onset of Action | Duration of Action | Advantages | Disadvantages |
|---|---|---|---|---|
| Hydration with saline (≤6 L/d) | Hours | During infusion | Rehydrates; rapid action | Volume overload; electrolyte disturbance |
| Forced diuresis (furosemide along with aggressive hydration) | Hours | During treatment | Rapid action | Monitoring required to avoid dehydration |
| Pamidronate 30-90 mg IV over 4 h | 1-2 days | 10-14 days | High potency; intermediate onset of action | Fever in 20%, ↓ Ca, ↓ phosphate, ↓ Mg, rarely jaw necrosis |
| Zoledronate 4-8 mg IV over 15 min | 1-2 days | >3 weeks | High potency; prolonged action; rapid infusion | Minor: Fever; rare ↓ Ca, ↓ phosphate, jaw necrosis |
| Calcitonin (2-8 U/kg SC q6-12h) | Hours | 1-2 days | Rapid onset | Limited effect; rapid tachyphylaxis |
| Glucocorticoids (prednisone 10-25 mg PO qid) | Days | Days-weeks | Useful in myeloma, lymphoma, breast CA, sarcoid, vitamin D intox | Effects limited to certain disorders; glucocorticoid side effects |
| Dialysis | Hours | During use-2 days | Useful in renal failure; immediate effect | Complex procedure |